AAOS Now

Published 3/1/2014
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Cheryl Toth, MBA

How Do You Spell ICD-10 Success?

Teamwork pays off for Nebraska practice

New West Sports Medicine & Orthopaedic Surgery, Kearney, Neb., is a seven-surgeon practice with seven physician assistants (PAs) and four athletic trainers (ATs). It’s also ready to face the challenges presented by the transition to the International Classification of Diseases, 10th edition (ICD-10) in October. Their success is based on one word: TEAMWORK. Their ICD-10 transition team is a tour de force for leading and motivating the entire practice.

Early action pays off
New West officially kicked off its ICD-10 planning last September, but informal planning occurred during many conversations prior to that date.

Administrator Carol Swanson credits early action to the support she and staff got from the physicians. “They understood that ICD-10 is where things are going, whether we like it or not,” she recalled. “Their attitude was ‘why not prepare for it and do it the best we can?’”

Ms. Swanson attended two AAOS-sponsored coding and reimbursement workshops conducted by KarenZupko & Associates in 2013, and she took another staff person along to the second course. “When we came back from that workshop, we agreed that we’d better act fast to avoid a train wreck,” she said. “It was a huge turning point. It was the wake-up call to all the physicians, PAs, and scribes that we’d better do something.”

And do something they did.

Following the practical advice provided in the workshops, the practice quickly assembled a transition team to lead the preparation process, arrange for clinical and nonclinical staff education and webinars, and develop a centralized calendar to track important dates and deadlines.

“The centralized calendar is posted in the procedure room,” said Ben Pfannenstein, project manager. “It keeps everybody in the loop and holds people accountable. And it’s an easy way to make changes visible.”

A team approach to details
Last fall, team members began contacting their electronic health records (EHR) vendor and payers for testing plan details. Getting information from payers was relatively easy, according to Jennifer Verbeck, billing lead. “A lot of them had the information on their website, and it was easy to find.”

Ms. Verbeck organized the data in an Excel spreadsheet, then trained her team to add to it each time they spoke with a payer. “Every member of the billing team is empowered to add information and make changes to the spreadsheet,” she explained. “If a staff member is speaking with a payer and notices that we don’t have that payer’s testing plan details, the staff member will ask when testing can begin and add the information to the spreadsheet.”

The practice quickly realized it needed to add staff so Ms. Verbeck could focus on the ICD-10 conversion tasks. A new full-time coder was recruited last fall and will stay beyond the Oct. 1, 2014, conversion deadline. The new coder will also enable the practice to attain other goals. “We want to decrease the lag time from patient appointment to claims submission and make other reimbursement system improvements,” said Ms. Verbeck.

Concurrent with transition team actions, Ms. Swanson arranged for a variety of ongoing training—particularly webinars, which coding staff, physicians, nonphysician providers, and EHR scribes attended together. “We wanted to focus our time and money on the best, most specific educational programs for our industry and specialty,” Ms. Swanson explained. “So we selected webinars sponsored by the AAOS, the American Association of Orthopaedic Executives, and the Centers for Medicare & Medicaid Services.”

The practice found the collaborative approach of watching webinars as a group was particularly effective for physician training. It fostered cohesiveness and enabled the PAs and ATs to confirm information and key concepts with the surgeons. “It was a good way to show that the practice’s administration staff wasn’t making mountains out of molehills,” saidMs. Swanson.

Training remains a “work in progress,” according to Ms. Swanson, and will continue in 2014. The practice plans to send multiple team members to Academy-sponsored coding and reimbursement courses. Because one of the PAs is also skilled at teaching, anatomy training classes for the billing staff will also be conducted on several Saturdays.

What’s next
The practice identified its top 25 diagnoses just before the end of the year and purchased the ICD-10 draft book. Currently, Denise Sinsel, coding lead, is mapping the practice’s top 25 diagnoses to their ICD-10 equivalents, using the Academy’s 2014 Code-X product. “This tool is a great resource for all our coders,” Ms. Swanson said.

After code maps are completed, Ms. Sinsel will review current documentation and determine what needs to improve to meet ICD-10 requirements. She predicts that changing documentation habits will be a big challenge. “In the past, our physicians and nurses didn’t have to do any coding,” she said. “They dictated the note, and the coding team reviewed it and selected the codes. This began to change when we implemented the EHR, but that was ICD-9. Now, physicians and clinicians have to know so much more to document in a way that enables the coder to choose the right code.”

The transition team has already established quarterly goals for 2014, as follows:

  • First quarter—Complete code maps for the top 25 diagnosis codes, review documentation and identify areas that need improvement, complete physician documentation training, and begin early testing with payers.
  • Second quarter—Continue testing and improve physician documentation.
  • Third quarter—Complete all tasks and training and begin coding with ICD-10.

As deadlines are reached and new tasks are added or modified, the centralized calendar will be used to inform the entire practice.

Best advice
What’s the secret to New West’s success? Ms. Swanson gives credit to the physician leaders. “It starts from the top. You’ve got to embrace it and get everyone else on board,” she said.

Mr. Pfannenstein adds that practices have to realize that one person can’t do it all. “You have to delegate responsibility and trust the leads in each area to help you,” he advised. “The transition and preparation need to be a team effort and objectives and tasks need to be clear.”

Ms. Sinsel says practices must be willing to invest in the right books, tools, and training so staff can be successful. “The fact that our staff are getting anatomy training and access to webinars gives us the confidence that we can be accurate and make the transition work.”

Ms. Verbeck believes the team at New West works because “we have specific people who are responsible for specific things, but everyone participates and works together. No one person has to do it all.”

For more information and resources on ICD-10, visit www.aaos.org/icd10

Cheryl Toth, MBA, is a consultant with KarenZupko & Associates. She brings more than 20 years of consulting, executive management, training, and technology development to her projects.

Anatomy of an ICD-10 Transition Team
In addition to attending monthly meetings, updating staff, and attending educational sessions, team members perform the following tasks:

Billing Lead

  • Obtain ICD-10 details from payers
  • Evaluate documentation to identify necessary changes for ICD-10
  • Keep the billing department up-to-date

Project Manager

  • Work with electronic health record/practice management system vendors to ensure software and hardware readiness
  • Manage deadlines and keep team on task

Coding Lead

  • Map top 25 diagnosis codes to ICD-10
  • Keep coding department up-to-date on all projects related to ICD-10

Transition Lead (Administrator)

  • Organize webinars and meetings
  • Manage the ICD-10 tracking calendar
  • Assign team member tasks

New West’s Top 3 Challenges & Solutions

  1. Documentation shortfalls: The transition team worked with the nursing staff to improve initial patient interviews and develop easier ways to capture essential data.
  2. Buy-in from everyone: This improved as staff attended webinars together and received more ICD-10 information.
  3. Time: With so many changes happening in 2014, the team’s attitude was one of ‘just dig in and get it done—trust your people to participate in the process.’